Cardiket
Cardiket: instructions for use and reviews
- 1. Release form and composition
- 2. Pharmacological properties
- 3. Indications for use
- 4. Contraindications
- 5. Method of application and dosage
- 6. Side effects
- 7. Overdose
- 8. Special instructions
- 9. Application during pregnancy and lactation
- 10. Use in childhood
- 11. In case of impaired renal function
- 12. For violations of liver function
- 13. Use in the elderly
- 14. Drug interactions
- 15. Analogs
- 16. Terms and conditions of storage
- 17. Terms of dispensing from pharmacies
- 18. Reviews
- 19. Price in pharmacies
Latin name: Cardiket
ATX code: C01DA08
Active ingredient: isosorbide dinitrate (isosorbide dinitrate)
Producer: AG Schwartz Pharma (Germany)
Description and photo update: 2019-16-08
Prices in pharmacies: from 56 rubles.
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Cardiket is a drug used to relieve and prevent attacks of angina pectoris, as well as to treat other manifestations of coronary insufficiency in coronary heart disease.
Release form and composition
Cardiket is produced in the form of prolonged-release tablets: white, round, on the one hand - convex, with the inscription "SCHWARZ PHARMA", on the other - flat, with a line, beveled and engraved: under the line (depending on the dose) - "20", "40" or "60", above the line - "IR" (10 pcs. In blisters, 2 or 5 blisters in a cardboard box).
The composition of 1 tablet includes:
- Active ingredient: isosorbide dinitrate - 20, 40 or 60 mg;
- Auxiliary components: lactose monohydrate, talc, magnesium stearate, potato starch, polyvinyl acetate.
Pharmacological properties
Pharmacodynamics
Isosorbide dinitrate is a peripheral vasodilator that acts primarily on the venous vessels. Differs in antianginal and hypotensive effects. The mechanism of action is due to the main endothelial relaxing factor - the release of nitric oxide in the vascular endothelium, as a result of which intracellular guanylate cyclase is activated and the level of cyclic guanosine monophosphate (a mediator of vasodilation) increases. Cyclic guanosine monophosphate stimulates cGMP-dependent protein kinase, which disrupts the phosphorylation of certain proteins of smooth muscle cells (including the light chain of myosin). This effect leads to a decrease in contractility and relaxation of vascular smooth muscles.
Isosorbide dinitrate acts on peripheral veins and arteries. The relaxation of the veins decreases venous return to the heart (preload), which leads to a decrease in the filling pressure of the left ventricle. To a lesser extent, there is an expansion of arterial vessels, which leads to a decrease in blood pressure and a decrease in the total peripheral vascular resistance (afterload).
Due to a decrease in pre- and afterload, oxygen consumption by the myocardium decreases.
The drug redistributes coronary blood flow in favor of the subendocardial zones, especially in atherosclerosis of the coronary arteries (mainly large). Due to vasodilation of collateral arteries, myocardial blood supply can be improved. The drug reduces oxygen consumption by the myocardium, improves oxygen transport to ischemic areas, and reduces the zone of myocardial damage.
In chronic heart failure, isosorbide dinitrate improves hemodynamics both during exercise and at rest.
After taking Kardiket, there is a decrease in blood flow to the right atrium, which helps to reduce pressure in the pulmonary circulation, as well as regression of symptoms observed with pulmonary edema.
Isosorbide dinitrate promotes vasodilation of the brain and dura mater, as a result of which headaches can be observed.
The use of this substance leads to relaxation of the smooth muscles of the bronchi, urinary and biliary tract, and the gastrointestinal tract.
As with other nitrates, cross-tolerance develops to isosorbide dinitrate. Sensitivity to Kardiket quickly recovers after withdrawal and interruption in treatment. To prevent the onset of tolerance, a daily, preferably nighttime, "nitrate-free interval" should be adhered to for 8-12 hours. For most patients, this treatment is more effective than continuous therapy.
Pharmacokinetics
When taken orally, isosorbide dinitrate is rapidly absorbed. Compared to conventional tablets, the relative oral bioavailability of the sustained-release drug is over 80%. The effect is manifested in 0.25-0.5 hours, and the time to reach the maximum concentration in the blood plasma ranges from 15 minutes to 1-2 hours. As a result of metabolism in the liver, two main active metabolites are formed: isosorbide-2-mononitrate with a half-life of 1.5 to 2 hours and isosorbide-5-mononitrate with a half-life of 4 to 6 hours. It is excreted by the kidneys (mainly in the form of metabolites).
Indications for use
- Chronic heart failure (concomitantly with cardiac glycosides, diuretics and / or angiotensin-converting enzyme inhibitors);
- Long-term therapy of ischemic heart disease: prevention of angina attacks;
- Secondary prevention of myocardial infarction and therapy with persistent angina pectoris (simultaneously with other drugs).
Contraindications
- Hemorrhagic (apoplectic) stroke;
- Acute vascular insufficiency (vascular collapse, shock);
- Severe stenosis (mitral and / or aortic);
- Acute myocardial infarction, accompanied by severe arterial hypotension;
- Severe arterial hypotension (with systolic pressure less than 90 mm Hg);
- Angle-closure glaucoma, accompanied by high intraocular pressure;
- Traumatic brain injury;
- Hypovolemia;
- Simultaneous use with phosphodiesterase type 5 inhibitors (such as sildenafil, tadalafil or vardenafil), since these drugs potentiate the hypotensive effect of nitrates;
- Age up to 18 years (the efficacy and safety of taking Kardiket for this age group of patients have not been established);
- Hypersensitivity to drug components.
Relative contraindications to therapy are:
- Severe anemia;
- Toxic pulmonary edema;
- Hypertrophic obstructive cardiomyopathy (due to the possible risk of increased frequency of angina attacks);
- Cardiac tamponade;
- Cerebral hemorrhage;
- Constrictive pericarditis.
According to the instructions, Cardiket should be taken with caution and under close medical supervision: elderly patients, as well as patients with a tendency to dysregulation of blood circulation due to low blood pressure (with orthostatic disturbances in the regulation of blood circulation), with severe liver failure (due to the risk of developing methemoglobinemia), severe renal failure, hyperthyroidism, increased gastrointestinal motility, malabsorption syndrome, diseases that are accompanied by an increase in intracranial pressure.
Breastfeeding and pregnant women should take Cardiket only in cases where the intended benefits to the health of the mother are higher than the possible risk to the child and / or fetus.
Instructions for use of Kardiket: method and dosage
Cardiket is taken orally with a small amount of liquid. Do not chew the tablets. The drug can be taken regardless of mealtime.
The dosage regimen is determined by the indications and dosage form:
- 20 mg: 2 times a day, 1 tablet. If necessary, it is possible to increase the frequency of taking the drug up to 3 times a day;
- 40 mg: 1 tablet once a day or 1/2 tablet 2 times a day. If necessary, Kardiket can be taken 2 times a day, 1 tablet (it is recommended to take the second tablet within 8 hours after taking the first);
- 60 mg: 1 tablet once a day. If necessary, it is possible to increase the frequency of taking the drug up to 2 times a day (the second tablet is recommended to be taken within 8 hours after taking the first).
Treatment should be started with minimal doses. Increase the dose to the most effective dose gradually. The duration of therapy is determined by the doctor individually. Kardiket is intended for long-term therapy, and you should not abruptly stop taking Kardiket without a doctor's instructions.
Side effects
While taking Cardiket, the following violations may be observed:
- Cardiovascular system: At the beginning of the treatment course, a "nitrate" headache may occur, which usually goes away on its own within a few days. Sometimes, at the first intake of Kardiket or with an increase in the dose, a pronounced decrease in blood pressure is observed, especially when the patient gets out of bed, which may be accompanied by lethargy, tachycardia, as well as a feeling of weakness and dizziness. In rare cases, with a pronounced decrease in blood pressure, signs of angina pectoris may increase (a paradoxical increase in angina attacks). In extremely rare cases, collaptoid conditions are observed, accompanied by syncope (sudden loss of consciousness) and bradycardia;
- Central nervous system: stiffness, blurred vision, drowsiness, decreased ability to rapid motor and mental reactions (especially at the beginning of the course of therapy); rarely - cerebral ischemia;
- Digestive system: rarely - belching, nausea, dry mouth, vomiting, abdominal pain;
- Allergic reactions: skin rash;
- Others: exfoliative dermatitis, the development of tolerance (including crossover to other nitrates), facial flushing.
Overdose
Symptoms: a marked decrease in blood pressure with vasodilation, headache, reflex tachycardia. The appearance of pallor, "threadlike" pulse, increased sweating, weakness, dizziness (including postural), nausea, vomiting, skin flushing, diarrhea is possible. When taken in high doses (over 20 mg per 1 kg of body weight), there is a risk of cyanosis, methemoglobinemia, tachypnea, dyspnea (due to the formation of nitrite ions due to the metabolism of isosorbide mononitrate), anxiety, loss of consciousness, cardiac arrest. Probably, these symptoms may be due to an overdose of isosorbide dinitrate. In the case of taking very high doses of Kardiket, an increase in intracranial pressure with cerebral symptoms is possible. Chronic overdose can cause an increase in methemoglobin.
Therapy: in the presence of symptoms of overdose, oral administration of Kardiket should be discontinued, gastric lavage, activated charcoal should be prescribed.
In the case of a state of shock and / or a pronounced decrease in blood pressure, it is required to place the patient in a horizontal position, raise his legs and ensure that measures are taken to restore the volume of circulating blood (BCC). To improve blood circulation, in exceptional cases, it is allowed to infuse dopamine and / or norepinephrine (norepinephrine). The administration of adrenaline (epinephrine) and analogs is contraindicated.
With methemoglobinemia, the following are prescribed:
- ascorbic acid - orally (1 g) or intravenously in the form of sodium salt [from 0.1 to 0.15 ml / kg of 1% solution (up to 50 ml)];
- hemodialysis, oxygen therapy, exchange blood transfusion.
special instructions
To stop the attacks of angina pectoris, Cardiket should not be used.
During the period of therapy, it is necessary to monitor blood pressure and heart rate.
With prolonged continuous use of Kardiket, the development of tolerance is possible, as well as the development of cross-tolerance to other drugs of the nitrate group. To prevent a decrease in its effectiveness, constant therapy with high doses should be avoided.
In acute heart failure or acute myocardial infarction, Cardiket should be taken only with close clinical observation of the patient.
Patients with primary pulmonary disease may develop temporary hypoxemia during therapy. In ischemic heart disease, this can lead to the development of transient myocardial ischemia.
To avoid an increase in the frequency of angina attacks, it is recommended to avoid abrupt withdrawal of therapy.
In the event of an attack of angina pectoris, it is necessary to additionally apply fast-acting nitrates to stop it.
To prevent unwanted lowering of blood pressure, the dose of Kardiket should be selected individually.
During therapy, a decrease in blood pressure and the development of dizziness may occur with a sharp transition from the "lying" or "sitting" position to an upright position, against the background of the use of ethanol, during exercise and in hot weather, as well as increased angina pectoris with a sharp decrease in blood pressure, ischemia up to myocardial infarction and sudden death (paradoxical "nitrate reactions").
The intensity of the headache can be reduced by lowering the dose of Kardiket and / or by simultaneously taking menthol-containing agents (eg, validol).
With frequent use of Kardiket without interruption, addiction may develop, which requires an increase in the dose. To prevent the development of tolerance, it is recommended to observe the "nitrate-free interval" daily for 8-12 hours, preferably at night. In most patients, this method of taking the drug is more effective than continuous therapy.
If, while taking Kardiket, dry mouth or blurred vision persists or is severe, therapy should be discontinued.
During the period of treatment, alcohol consumption must be excluded.
When using Kardiket from driving vehicles and performing potentially hazardous types of work that require a high concentration of attention and quick psychomotor reactions, one should refrain.
Application during pregnancy and lactation
When treating pregnant and lactating women, the drug should be used with caution.
Since clinical studies of the use of Kardiket during pregnancy have not been conducted, the use of the drug during gestation is allowed only in cases where the potential risk to the fetus is less than the intended benefit to the mother. In this case, careful monitoring of the condition of the pregnant woman and the fetus should be ensured.
There is information on the excretion of nitrates in breast milk, but the exact concentration of isosorbide dinitrate and its metabolites in breast milk has not been determined. There is evidence of the possibility of developing methemoglobinemia in infants, therefore, taking Kardiket during breastfeeding should be carried out with caution.
Pediatric use
It is forbidden to use Kardiket to treat patients under the age of 18.
With impaired renal function
In severe renal failure, the drug should be used with caution.
For violations of liver function
In severe hepatic impairment, Cardiket should be used with caution.
Use in the elderly
When treating elderly patients, dose adjustment of Kardiket is not required.
Drug interactions
With the simultaneous use of Kardiket with some drugs, undesirable effects may occur:
- Beta-blockers, other vasodilators (vasodilators), antihypertensive drugs, slow calcium channel blockers, phosphodiesterase 5 inhibitors used in the treatment of erectile dysfunction, tricyclic antidepressants and antipsychotics, quinidine, novocainamide, as well as ethoxybenzivol: enhancing the action
- Dihydroergotamine: an increase in its concentration in the blood and, thus, an increase in the hypotensive effect;
- Sympathomimetic agents, alpha-blockers: decrease in the antianginal action of isosorbide dinitrate;
- M-anticholinergics (atropine): an increase in the likelihood of increased intraocular pressure;
- Astringents, absorbents and coating agents: reducing the absorption of isosorbide dinitrate into the gastrointestinal tract.
In the treatment of coronary heart disease, it is rational to use Kardiket simultaneously with amiodarone and other drugs, such as blockers of slow calcium channels (nifedipine, verapamil), propranolol.
The combined use of Kardiket and acetylsalicylic acid contributes to the improvement of coronary circulation.
Analogs
Kardiket's analogues are: Nitrosorbide, Nitrosorbid-Rusfar, Izoket, Izodinite, Izomik, Dikor Long.
Terms and conditions of storage
Keep out of reach of children at temperatures up to 25 ° C.
The shelf life is 5 years.
Terms of dispensing from pharmacies
Dispensed by prescription.
Reviews about Cardiket
Reviews about Kardiket are mostly positive: the drug quickly improves the work of the heart muscle. The most common side effects are headaches of varying intensity.
Price for Cardiket in pharmacies
The approximate price for Cardiket is: 20 tablets 20 mg - 70 rubles, 50 tablets 20 mg - 130 rubles, 20 tablets 40 mg - 115 rubles, 50 tablets 40 mg - 225 rubles.
Cardiket: prices in online pharmacies
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Drug name Price Pharmacy |
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Kardiket tablets prolonged action 20mg 20 pcs. RUB 56 Buy |
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Cardiket 40 mg extended release tablets 50 pcs. 183 r Buy |
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Maria Kulkes Medical journalist About the author
Education: First Moscow State Medical University named after I. M. Sechenov, specialty "General Medicine".
Information about the drug is generalized, provided for informational purposes only and does not replace the official instructions. Self-medication is hazardous to health!
